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Interindividual Sleep Variability Across the Psychosis Spectrum: A Systematic Review and Meta-Analysis
Rosario Aronica1,2,3, John Torous4, Amedeo Minichino1,2,5
1Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, United Kingdom.
JAMA Network Open
|July 22, 2026
Summary
Individuals at clinical high risk for psychosis (CHR-P) and those with schizophrenia spectrum disorders (SSDs) exhibit greater sleep variability than healthy controls. This highlights sleep patterns as potential biomarkers for personalized psychosis treatment strategies.
Area of Science:
- Psychiatry and Sleep Science
- Digital Phenotyping in Mental Health
- Neuroscience and Behavioral Research
Background:
- Sleep disturbances are prevalent across the psychosis spectrum, often preceding core clinical symptoms.
- Existing research primarily focuses on average sleep patterns, neglecting interindividual variability crucial for tailored care.
- Understanding sleep variability can offer insights into psychosis pathophysiology and inform personalized treatment approaches.
Purpose of the Study:
- To quantify and compare interindividual variability in actigraphy-based sleep measures.
- To examine sleep variability across different stages of psychosis, including clinical high risk for psychosis (CHR-P) and schizophrenia spectrum disorders (SSDs).
- To compare sleep variability in CHR-P and SSD groups against healthy control participants.
Main Methods:
- Systematic review and meta-analysis of 18 case-control studies utilizing wrist actigraphy.
- Inclusion of studies comparing individuals with CHR-P or SSDs to healthy controls.
- Primary outcome: natural logarithm of the variability ratio (lnVR) for total sleep time (TST); secondary outcomes included other sleep parameters (TIB, WASO, sleep efficiency).
Main Results:
- Individuals at CHR-P showed significantly greater variability in time in bed (TIB), wake after sleep onset (WASO), and sleep efficiency compared to controls.
- Individuals with SSDs exhibited significantly greater variability in TST, TIB, WASO, and sleep efficiency compared to controls.
- No significant moderator effects of antipsychotic use, age, or sex were found on sleep variability.
Conclusions:
- Distinct digital sleep phenotypes characterized by increased variability were identified in individuals across the psychosis spectrum.
- These findings underscore the potential of sleep variability as a biomarker for stratifying care in psychosis.
- Further research is warranted to explore the clinical utility of sleep variability metrics in psychosis management.
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